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Friday, February 19, 1999 Published at 07:20 GMT


Oral epilepsy medication 'will save lives'

Epileptic patients need quick treatment

Scientists have developed an oral medication that could save the lives of people who suffer from a severe form of epileptic seizure.

Convulsive status epilepticus is a single, prolonged epileptic seizure or a series of short epileptic seizures, during which the patient remains unconscious.

The episode usually lasts for at least 30 minutes, and can be life-threatening. Patients often require admission to intensive care units.

There are 25,000 seizures of this kind in UK each year, frequently in children.

It is important to administer treatment as quickly as possible, usually before admission to hospital.

There is increasing evidence that the longer seizures persist, the more difficult they are to stop.

Prompt treatment leads to fewer drugs being required in hospital and a reduction in the overall seizure length.

But until now the only treatment that could be administered by a non-medical person was a liquid form of the drug diazepam administered through the rectum.

However, the rectal administration of diazepam when a patient is having a seizure is very difficult.

When a large child or adult is having a seizure, a caregiver may not be able to remove the necessary clothes, bend the knees,and introduce the tip of the syringe into the rectal cavity.

Rectal administration in a public place is also fraught with problems. Many parents, teachers and carers are reluctant to administer rectal medication for fear of allegations of sexual abuse.

Writing in the medical journal The Lancet, Dr Rod Scott and colleagues say they have developed a more convenient treatment.

This involves squirting the drug midazolum from a syringe into the space in the mouth cavity between the cheek and teeth.

Child tests

Dr Scott and his colleagues tested the new technique on children who had severe epilepsy and who were in a residential school with its own medical facilities.

When seizures lasted for longer than 5 minutes, they were randomly administered diazepam via the rectum, or the oral midazolum treatment.

The number of seizures that were stopped by the two treatments was similar.

Dr Scott and colleagues conclude: "Buccal midazolam is at least as effective as rectal diazepam in the acute treatment of seizures.

"Placing medication into the mouth is likely to carry little social stigma, whereas the need to use the rectal route is potentially highly stigmatising.

"Carers are more likely to treat seizures early when a socially acceptable route is available."

Dr Scott told BBC News Online that the new treatment could undoubtedly save lives.

"It is very clear from research studies that the longer people suffer from seizures, the more likely they are to experience brain damage or die.

"Treating people very early with this socially acceptable method is likely to save lives."

Reviewing the research in Lancet commentary piece, Dr Gregory Holmes from Boston, USA, supports the use of midazolum administered via the mouth, but adds that age-related doses should be investigated.

He said: "Whether differences in response rate would have emerged if the dose was based on weight (as is usual for children) is not clear".

Professor John Duncan, medical director of the National Society for Epilepsy, also welcomed the progress on oral midazolum.

He said: "A spray would be more convenient. Some relatives and professional carers are reluctant to give drugs rectally. They feel it is improper. Giving a mouth spray is much easier."

He added that a spray would also protect the dignity of the patient.

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